Illinois Health Insurance

The Land of Lincoln is rich in history as it is in health insurance options for individuals, families, and low-income residents.

Illinois is the sixth most populous U.S. state with approximately 12.7 million people.¹ However, just five insurance companies offer 2020 Obamacare plans state. Illinois’ public health insurance programs for low-income earners are much more robust. For example, enrollees in the state’s Medicaid and Children’s Health Insurance Program make up a fifth of the total population. There’s also a high number of Illinoisans enrolled in Medicare.

Below are highlights about Illinois and the Affordable Care Act (ACA). Plus, we’ve summarized different types of health insurance options available to Illinois residents.

How Has the Affordable Care Act Impacted Illinois?

Illinois’ uninsured population declined rapidly after the passage of the 2010 Affordable Care Act (ACA), also called Obamacare. Uninsured rates in Illinois fell by nearly 50% between 2010 and 2018. As a result, more than 880,000 Illinoisans gained coverage.

Illinois’ decision to expand Medicaid under the ACA led to more people having health insurance. Before 2014, single adults without dependents weren’t eligible for Medicaid, no matter their income. But 700,700 single adults (as of Oct. 2019) now have coverage thanks to Illinois’ Medicaid expansion. This increase accounts for about 28% of Illinois’ 2.5 million Medicaid enrollees.²

Illinois Health Insurance Marketplace Enrollment

Illinois operates a Health Insurance Marketplace in partnership with the federal government called Get Covered Illinois.³ You can apply for individual or family health insurance through the Marketplace, over the phone, by mail, or in-person at consumer assistance centers located statewide. This also applies if you’re a self-employed entrepreneur with no employees.

Open enrollment for health insurance in Illinois (both on and off the exchange) generally runs from November 1 to December 15 each year. After this date, you can only enroll in Obamacare if you have a qualifying life event.

Illinois Marketplace enrollment has declined every year since 2016. More than 388,000 residents were enrolled back then compared to about 312,000 in 2019.⁴ This downward trend is prevalent nationwide. It is partially due to reduced federal funding, shorter enrollment deadlines, and general uncertainties surrounding the ACA.⁵ 

Medicare Enrollment and Coverage Options in Illinois

Illinois has the seventh-highest number of Medicare beneficiaries of any state. More than 2.2 million residents enrolled as of 2018. Approximately 78% are Original Medicare enrollees. The rest signed up for Medicare Advantage plans sold by private insurance companies.⁶

Some residents also get Medicare Advantage through group retiree programs. For instance, members of Illinois’ Teachers’ Retirement Insurance Program have access to Medicare benefits through Total Retiree Advantage Illinois (TRAIL). TRAIL is a Medicare Advantage plan that offers medical and prescription drug coverage to eligible members and their dependents.

If you’re an Original Medicare member, you can enroll in Medicare Supplement (also called Medigap)  to help pay out-of-pocket expenses, such as copays and deductibles. In Illinois, Medicare beneficiaries under 65 receive the same open enrollment rights as seniors. Illinois law also mandates that insurers can’t charge people under 65 more for a policy than they would a senior. 

Because Original Medicare doesn’t cover most prescription drugs, many beneficiaries also add a separate Medicare Part D drug plan. In 2018, more than 1.1 million Illinois beneficiaries enrolled in these plans.

Illinois Companies Offering Individual and Family Plans

Illinois has eight insurance companies offering 2021 Marketplace plans, including three new entrants.⁷ Residents in most counties can choose from more than one insurance carrier. Health Care Service Corporation (aka Blue Cross Blue Shield) is the only carrier that offers plans statewide. The other four offer plans in select counties.

1. Bright Health Insurance Company of Illinois
2. Celtic Insurance Company 
3. CIGNA HealthCare of Illinois
4. Quartz Health Benefit Plans Corporation 
5. Health Alliance Medical Plans (new)
6. Health Care Service Corporation, (HCSC, aka Blue Cross Blue Shield) 
7. MercyCare HMO (new)
8. SSM Health Plan (new)

Illinois Health Insurance Costs for Marketplace Plans

Overall premium rates in Illinois have decreased for 2020 bronze, silver, and gold plans.⁸ The lowest-cost silver plan will drop by 5% on average across all regions where plans are available.⁹

Below are the average Illinois health insurance premiums from 2019 to 2020.¹⁰

Average Monthly Cost for Illinois Marketplace Plans

Federal Subsidies for Low-Income Illinoisans

In 2019, 86% of Illinois Marketplace enrollees received premium tax credits to lower their monthly premiums. Meanwhile, 43% received cost-sharing reductions on silver plans to help reduce out-of-pocket expenses like copays and prescription drug costs.

Subsidies are based on your income and household size. For example, you must earn between $12,760 and $51,049 a year in 2020 to qualify as a single person. A family of four must earn between $26,200 and $104,800.¹¹

Here are some examples of how much you could pay after subsidies:

• A 30-year-old in Chicago, IL earning $25,000 a year, could pay $135 per month for a 2020 silver plan after subsidies ($314 without them). If this same person earned around $17,200 or less, he would most likely qualify for Medicaid instead of subsidies for private health insurance.

• A family of four in Peoria, IL earning $50,000 a year could pay $259 per month for a 2020 silver plan after subsidies ($1,517 without them). If this same family earned $35,000 or less, they’d likely qualify for Medicaid instead of subsidies.¹²

Check a 2020 subsidy chart and calculator to see which subsidies you might qualify for.

Illinois Health Insurance Programs for Low-Income Adults and Children

The Illinois Department of Healthcare and Family Services offers several health insurance programs for low-income residents. Benefits are available to eligible adults under 65, seniors ages 65 and older, disabled individuals, families, children, pregnant women, and women with breast/cervical cancer. 

Medicare Cost Savings Program 

Illinois offers financial assistance with Medicare Part B premiums, coinsurance, and deductibles to beneficiaries with low income. You qualify if your maximum individual income is $12,760 a year (as of 2020), which is equivalent to 100% of the federal poverty level (FPL). Cost savings are provided through Illinois’ Qualified Medicare Beneficiaries (QMB) program, which is jointly funded by the federal government.^{13 12}

Medicaid

Illinois’ Medicaid program is generally provided for a low or no monthly cost to low-income residents, including:¹²

• Single, childless adults ages 19 to 64 earning up to 138% of the federal poverty level (FPL). This amounts to $1,467 a month in 2020. 
• Children under 19 in households that earn up to 147% of the FPL. 
• Aged (65+), blind, and disabled individuals earning up to 100% of the FPL.
• Former foster care youths up to age 26 regardless of income.
• Workers with disabilities earning up to 350% of the FPL. These individuals can buy into Medicaid for a small monthly premium.

Illinois’ Breast and Cervical Cancer Program 

Illinois offers a Breast and Cervical Cancer Program (BCCP) that provides enhanced Medicaid funding for screenings and treatment to eligible women earning up to 200% of the FPL. Although  women of all incomes qualify, funding for care could be less if they have not enrolled in Medicaid.

Health Coverage for Low-Income Families, Pregnant Women, and Children

If you’re pregnant or the custodial parent/caretaker of a child under 18, you and your family could get health insurance for little or no monthly cost.* Illinois’ FamilyCare and All Kids programs provide this coverage.¹⁴

*American Indian and Alaska Native families don’t pay any premiums or copays for family coverage.

FamilyCare Programs

You qualify for FamilyCare as a parent or caretaker if you’re a citizen or legal resident earning up to 138% of the FPL. But if you’re a pregnant Illinois resident earning up to 213% of the FPL, you could get coverage regardless of your citizenship or immigration status.

All Kids Program

Illinois’ All Kids program offers medical, dental, vision, and prescription drug coverage to eligible children under 19 regardless of health or immigration status. All Kids is available to households with income levels ranging from 157% to 318% of the FPL.

Illinois Short-Term Health Insurance For Temporary Coverage Needs

Short-term health insurance plans in Illinois offer coverage for up to 181 but no renewals. Also, you can’t buy a new short-term plan within 60 days of ending another policy for similar coverage.

Short term health plans don’t count as major medical coverage and are not ACA compliant. However, they offer basic benefits for services like doctor visits and emergency care. Treatment for illnesses related to a pre-existing condition is generally not covered.

Short-term health plans can be helpful when you need to fill a temporary coverage gap. For instance, if you missed the ACA open enrollment deadline or you’re waiting for coverage to kick in at a new job. You can typically get a short-term health insurance policy within 24 hours.

That about covers it for all the different types of Illinois health insurance options available. Now you’re ready to make an informed decision about your health coverage needs.